National health security is defined as the state of existence in which the nation and its people are prepared for, protected from, and resilient in the face of catastrophe and related health consequences. Local health departments play a key role in achieving national health security. Dr. Steven Englender, director of the Center for Public Health Preparedness in Cincinnati, provides insight on what it’s like to prepare for the worst, while at the same time hoping for the best.
HealthScene Ohio: Can you list the different types of public health emergencies and provide a brief description of them?
Dr. Steven Englender: Public health is involved in a variety of types of disaster response it goes beyond our visual role of ensuring and providing immunizations, healthy moms/well baby, stuff like that, and beyond the usual recordable diseases. Outbreaks and even worse, epidemics and pandemics, are obviously public health emergencies currently. Ohio is one of the many states engaged in responding to hepatitis A, but when we’re talking about preparedness activity, we’re really talking about all hazards and disasters. Those can be both natural and man-made. Natural ones can include things like extreme weather, whether that’s drought and heat, ice storms and cold, hurricanes, and what’s going on with the East Coast now.
Man-made disasters can come in a variety of forms too. Simply the world that we live in poses dangers from all sorts of things that we create. In terms of disaster preparedness, you often hear the term CBRNE, which is Chemical Biological Radiation Nuclear and Explosives. These are categories of things that are, generally speaking, man-made. I think if you look at Hawaii with volcanic activity, that’s a natural catastrophe, at least if its localized. But one of the things that clearly defines disaster versus single event, public health gets engaged with mass causalities. That might be a disastrous event, but that’s not the type of thing that we plan for in ways to mitigate effects on population before these things occur.
If there’s a chemical release from a rail car incident, public health’s role in that, as opposed to emergency management and hazardous materials, our role would be to monitor the population that may be exposed and provide the risk guidance, assist with the decision-making for the types of things that we can do to avoid ill effects – and that is either shelter-in-place or evacuating.
Before nuclear, I think we can all remember Chernobyl, no such disaster ever occurred again. That was obviously not a terrorist attack, but concerns are high from homeland security about both dirty bombs, radiation dispersal devices, as well as small scale nuclear.
The likelihood of that is not public health’s role but being prepared, we’re there in the event where radiation monitoring of a population is needed.
Explosives, obviously, this is something the world has been dealing with. It doesn’t fall to public health to prevent that, but to ensure with our partners, at least in most U.S. plans and terminology, our partners in health care as part of emergency support function at least. Which is public health’s meta-goal, that the systems work to get help to those based on the degree of injury and the potential injury. That’s much like any other mass casualty, where public health itself is more of a supporting role, but we do have a role to play.
HSO: What are some recent public health emergencies that have occurred in Ohio?
SE: Chemical exposures are not infrequent in Ohio. The reality is that our railroad infrastructure is aging, derailments do happen and sometimes that can involve chemicals. Here, public health has somewhat a peripheral role, HAZMAT is going to be the group making assessments, and fire departments work with HAZMAT.
A while back, and this is more than a decade ago, there was a rail car filled with styrene (used as raw material in making foam cups) that started leaking and produced an exothermic reaction. Given the right circumstances, it’s supposed to expand and multiply the material. This was located near the municipal airport in Cincinnati and that airport is surrounded by residential homes. Because of this rail car that leaked for several days before it could be fully mitigated, we ended up indicating to people within a certain radius that they really ought to go elsewhere until fumes were under control. Public health’s role there was not only in helping determine who needed to be evacuated in Cincinnati but also, we have a chemical monitoring and detection piece that’s led by the health department. Our job with that is to monitor not the hot spot, but the edges of it for population exposure. The fire department is who goes in and deals with whatever the chemical event is. Our role was to monitor the neighborhoods with handheld devices that identify toxic fumes.
HSO: What role does public health play in the event of a natural disaster?
SE: For the kinds of weather-related disasters, our role may be unseen. The Ohio River floods infrequently, but that’s not something we can control. Nature has its way of being far more powerful than our attempts to tame it. But our role typically is not one you think about. Here, restaurants are along the river. They may get flooded. Our folks have to ensure that not only are they cleaned up appropriately but any foods that may have been contaminated by river water have been thrown out, which is not something that people think about necessarily, but is very important to protecting health.
HSO: Has Ohio ever been the target of a bioterrorism attack, either foreign or domestic?
SE: In terms of bioterrorism, we probably have to go back to the French and Indian War, where a general threw blankets from soldiers that had died of smallpox. Biologic terrorism has been a fairly rare event in the U.S. and not necessarily recognized at the time. For that, a good example is the cult group in Oregon who sprayed salmonella on salad bars to try and influence an election to have their leader be elected to the country court. That is a very interesting situation that we found out sometime after, and it’s not your usual form. Was that really terrorism? We didn’t call it that in the ’70s, but several cities in Ohio as well as across the nation continually monitor the air for select agents that could be used in a biologic incident – plague, tuberculosis and smallpox are monitored on a continuous basis, so we’re always looking for it. Fortunately, it has never been found. Vigilance is the price of freedom, and certainly, in the context of biologic events, significant monitoring goes on across the country to be able to have early indicators where that could happen.
A lot of states have syndromic surveillance, which is a method by which continuous monitoring is analyzed for trends. If there’s an increase in unusual events that are consistent with a biological agent, we would receive an alarm to look into it. Obviously, this doesn’t mean the events are the result of anything that isn’t natural, such as going back to school and an increase in respiratory disease or increase in flu-like symptoms that occur every winter during flu season. The bottom line is that there have been no biologic terrorism events of which I’m aware of. The potential for some has been created, in the work to better understand and prepare. For example, sterilized anthrax spores were supplied by Dugway Proving Ground, one of the army installations and had been done so for years. What was recently discovered was that the radiation that Dugway used to provide these samples of sterile, nonreproductive anthrax spores to research institutions throughout the world were in fact not fully sterile. This just shows how the potential for biologic agents comes in many unexpected ways.
HSO: What does it mean to shelter in place and what are some emergencies where this plan of action would be appropriate?
SE: Shelter-in-place is used when either the exposure by being outside or the agent or problem at hand has more risk of remaining outside. Typically, this will be caused by airborne stuff, so actions such as turning off the air conditioning and closing all the windows are needed. If this is summertime, things will be a little bit stifled because avoiding bringing in outside air would be the better method as opposed to getting out of the area. Evacuations are very disruptive, difficult to manage and difficult to ensure that people are really gone. It’s much easier to see that people are off the streets. So many of the chemical events that are expected to be short-lived would require the shelter-in-place. But, shelter-in-place would be the appropriate risk mitigation should there be a radiation dispersal device. Typically, these things would be predicted to have short-term and long-term effects. After a nuclear explosion, the first 24 hours are most critical to avoid fallout, then the risk decreases over time. But when radioactive particulates are attached to dust or products of an explosion, that’s another shelter in place situation, but for the much longer term.
HSO: How can citizens prepare themselves for impending health emergencies or other forms of crisis?
SE: We have long partnered with a multitude of agencies, most prominently the Red Cross about the basic tenets of preparedness: have a plan and make sure that you can get information. If you think back to the derecho “a series of intense thunderstorms” from Hurricane Ike, where a million people lost power in Ohio, getting information was very difficult. You can’t watch television if you have no power. You need batteries and a radio, or a crank radio, to get information. In terms of having a plan, it’s what you need to stay self-sufficient. Three days supply of food and water is minimum, two weeks is what we talk about if we have disruptions caused by a severe epidemic. Part of a plan is how do you meet up with loved ones? What are your points of contact? What relative out of town do you talk to the others in the family will also talk to in case you’re separated in terms of some sort of disastrous event, whether it’s a tornado or a terrorist event? People don’t think about it often. In the coastal areas like Florida, people who have heard this message kind of know about evacuations for hurricanes. I’m not sure that in areas that don’t face these reoccurring disasters have taken the message to heart as well.
HSO: What essentials constitute a robust emergency preparedness kit?
SE: Redcross.org is a great place to see the list of things you need. You need appropriate supplies for the number of people in your family. For water that’s a gallon a day per person. If possible, you put away and rotate several cases of water to ensure you have drinking water. You need to make sure you have food that is canned and ready to eat. You’re not going to have your microwave unless you’re one of the lucky people with a generator to replace the power if it goes out. Having a can opener and other utensils is important. There are a variety of suggestions for the kinds of things needed in Red Cross materials and linked from local health department agencies. People often forget medication, and it’s not necessarily easy to ensure that you have an extra month’s supply for those with chronic illness. For example, people who are on insulin need to have enough to get them through if you can’t get them to a pharmacy. In the types of disasters that destroy homes, people really need to have copies of their important papers, physically and on a flash drive, so you have records of the various things that, if your home is destroyed, are very hard to rebuild. If you prepare for it, it’s a much easier time through the difficult process of rebuilding your life. Lighting devices, flashlights and candles, these things are important because around this time of year it is dark more than half the time.
HSO: Where can citizens be directed to learn about, and remain abreast of, potential public health emergencies?
SE: Centers for Disease Control and Prevention, CDC.gov, has got an incredible compilation of information both for the general public as well as healthcare professionals. For emergency preparedness, there are vast resources including tips, reminders and infographics at many local health departments. Our webpages will link you to that information, it really doesn’t take a whole lot of searching.
Maggie Ash is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Dr. Steven Englender is a preventive medicine physician in Cincinnati. He received his medical degree from Case Western Reserve University School of Medicine and has been in practice for more than 20 years.
